Posted on 04/19/2003 12:50:29 PM PDT by WestCoastGal
TORONTO, April 18 — As Ontario health officials braced for a wider outbreak of the mysterious respiratory illness around Toronto in the coming days, criticism is beginning to mount that political and health care officials have made some critical miscalculations in their attempts to avert a broader epidemic.
For two weeks, the tone of health care officials and the local news media had been increasingly upbeat, stressing that the disease, severe acute respiratory syndrome, or SARS, was largely contained to a fixed number of people linked to a single chain of exposures beginning at one hospital. But reports have recently emerged that officials were slow to isolate a new cluster of patients in a Roman Catholic prayer group and that several of the stricken patients were inexplicably turned away at several hospitals while they potentially infected many others.
The new outbreak was not identified, and action was not taken to quarantine the group of 500, for more than a week after the initial exposure — leaving time for the disease potentially to have spread into the general population. There is already evidence it may have spread to a condominium outside Toronto and as far as Montreal.
Disease Has Canada Doubting Its Leaders By CLIFFORD KRAUSS
TORONTO, April 18 — As Ontario health officials braced for a wider outbreak of the mysterious respiratory illness around Toronto in the coming days, criticism is beginning to mount that political and health care officials have made some critical miscalculations in their attempts to avert a broader epidemic.
For two weeks, the tone of health care officials and the local news media had been increasingly upbeat, stressing that the disease, severe acute respiratory syndrome, or SARS, was largely contained to a fixed number of people linked to a single chain of exposures beginning at one hospital. But reports have recently emerged that officials were slow to isolate a new cluster of patients in a Roman Catholic prayer group and that several of the stricken patients were inexplicably turned away at several hospitals while they potentially infected many others.
The new outbreak was not identified, and action was not taken to quarantine the group of 500, for more than a week after the initial exposure — leaving time for the disease potentially to have spread into the general population. There is already evidence it may have spread to a condominium outside Toronto and as far as Montreal.
The second-guessing is already taking hold in Ontario, and it is beginning to jeopardize business confidence and become a rancorous political issue in the provincial legislature.
"Where's Rudy Giuliani when he's needed?" The Globe and Mail asked today in an editorial on SARS. "Toronto could use that kind of leadership now." The editorial said that Mayor Mel Lastman must take action or "should resign and let others lead."
"Toronto cannot now afford a vacuum at the top," it stated.
As the city most seriously stricken with the epidemic outside of Asia, Toronto has emerged as a test case of whether mass quarantines can be effective in containing the virus. Thirteen people have died from the disease here, and 251 of Canada's 306 probable or suspected cases have been reported within the greater Toronto metropolitan area. With little margin for error and the numbers of infected rising every day, every misstep or new outbreak causes more fear and fiercer criticism.
Another editorial, in The Toronto Star, argued that national and provincial leaders had not taken the disease seriously enough, and suggested that the government consider imposing jail terms on SARS patients who violate quarantines.
"Prime Minister Jean Chrétien and Premier Ernie Eves should be at the forefront of this issue," the editorial in The Star on Thursday contended, "but they have been virtually silent on it, except for token appearances at Chinese restaurants." Mr. Eves is the premier of Ontario.
The new outbreak and criticism have put Ontario health officials on the defensive.
"We're in a steep, steep learning curve," said Dr. Donald Low, microbiologist at Mount Sinai Hospital. "If we make mistakes we'll correct them. We're not out of the woods yet. This is a different animal than I've ever seen before."
Health officials say they are considering tougher measures, including the use of electronic bracelets to keep track of people in quarantine who are considered at risk to leave their homes.
With expected heavy church attendance at Easter, this weekend is considered a crucial hurdle. Medical and religious leaders are urging anyone with the slightest fever, body aches or other symptoms to stay home. Several major Toronto businesses have begun asking employees to work at home and either postpone meetings or use teleconferencing as a substitute.
Anglican and Roman Catholic churches have decided to change some traditional practices during services this weekend. There will be no calls for congregants to embrace one another and there will be no kissing of the cross or sharing of communal glasses of wine.
More than 7,000 people have been put into quarantine at home for 10 days over the last month around Toronto. Compliance has been almost total, with health officials having to take legal measures, like issuing court orders, to force 15 people to stay at home. About 650 remain in quarantine today.The biggest new potential outbreak — among the Bukas-Loob Sa Diyos Covenant Community, a primarily Philippine Roman Catholic prayer group — was disclosed on Monday, changing the mood of the city. As officials reported an outbreak of 29 cases, they had difficulty explaining why it took them until April 12, a week after members of the group became ill, to instruct the entire group to go into quarantine in their homes.
The new cluster originated when one member of the group contracted the virus at Scarborough Grace Hospital, where the entire Ontario outbreak began, and he passed it on to 17 members of his family. He died, as did his wife; neither of them have been publicly identified. Other family members spread the disease through the church group at a prayer meeting and at the man's funeral.
Particularly difficult to explain is how medical officials dealt with the couple's two exposed sons, one of whom was put in quarantine for 10 days and one of whom was not put in quarantine at all.
The son who was quarantined showed symptoms after the 10-day isolation, and was turned away at as many as three different hospitals. Apparently he did not show strong symptoms, forcing authorities now to consider anyone with flulike symptoms to be a possible case.
It will not be known until sometime next week how far the disease spread beyond the church group, whose 500 members have now been quarantined over the last week.
Fears grew when health care workers disclosed Thursday that a member of the group shared a vehicle with several people going to a business conference outside Montreal. Since the man came down with symptoms a day later, more than 400 people who attended the conference were forced to go into quarantine in Quebec, a province that has yet to have a SARS case.
Faced with questions from the local news media over whether officials made a blatant error, Dr. James Young, Ontario's commissioner of public safety, responded, "We've got a new illness with very little understood about it, a lot of trouble diagnosing it and a lot of confusion over who has to do what."
In another significant development, three new cases were reported in a 19-story condominium in the suburb of Scarborough that may or may not be related to previous cases.
Ontario health officials have conceded that their quarantine efforts have not been entirely effective and that they have made mistakes.
"There's always room for improvement," said Dr. Colin D'Cunha, Ontario's chief medical officer. He said that what was required now was the maintenance of a 100 percent ring around all suspected and possible cases.
"I'm not naïve," he added, "to think were totally safe
I know, can you even imagine?
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